Caffaro-Rouget et al. (1989)[18] found that 51% of their sample was symptomatic; in Mannarino and Cohen (1986),[19] 69% of forty-five assessed children were symptomatic; 64% of Tong, Oates, and McDowell's (1987)[20] forty-nine child sample were not within the normal range on the child behavior checklist; and in Conte and Schuerman (1987),[21] whose assessment included both very specific and broad items such as 'fearful of abuse stimuli' and 'emotional upset,' 79% of the sample was symptomatic. A minority of abused children have been found to be healthy and asymptomatic,[22][23][24] and the level of harm associated with the abuse may correlate with other factors.[9][10] Prescott and Kendler (2001) found that the risk of psychopathology increased if the perpetrator was a relative, if the abuse involved intercourse or attempted intercourse, or if threats or force were used. The age at which an individual was first abused did not appear to be related.[25] Other studies have found that the risk of adverse outcomes is reduced for abused children who have supportive family environments.[26][27]

Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse,[28] some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuse[10][29][30][31] and some have hypothesized "that abuse effects are at least in part the results of dysfunctional family dynamics that support sexual abuse and produce psychological disturbance (Fromuth, 1986) and that concomitant physical or psychological abuse may account for some of the difficulties otherwise attributed to sexual abuse (Briere & Runtz, 1990)."[32] Martin and Fleming, however, argue that, "in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects."[33]Rind et al.'s 1998 meta-analysis of studies using college student samples concluded that the relationship between poorer adjustment and child sexual abuse is generally found nonsignificant in studies which control for variables such as family environment and other forms of abuse.[22] Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.[29][10][14]

Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the effect size of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins.[29] After controlling for possible confounding variables, Widom (1999) found that child sexual abuse independently predicts the number of symptoms for PTSD a person displays. 37.5% of their sexually abused subjects, 32.7% of their physically abused subjects, and 20.4% of their control group met the criteria for a diagnosis of PTSD.The authors concluded, "Victims of child abuse (sexual and physical) and neglect are at increased risk for developing PTSD, but childhood victimization is not a sufficient condition. Family, individual, and lifestyle variables also place individuals at risk and contribute to the symptoms of PTSD."[13] Mullen and Fleming, argue that, "in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects."[34]